c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Appendicostomy: 1

A D V E R T I S E M E N T

   
 

Appendicostomy is useful for patients with fecal incontinence in whom antegrade enema therapies are needed. In patients known to have an appendix, a bowel preparation is not needed. (If the patient has no appendix, please see neoappendicostomy.) The patient is placed supine in the operating room. The existing left paramedian incision may be used or, as an alternative, a lower midline incision can be made. The cecum is mobilized away from the abdominal wall on the right side.     

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Appendicostomy: 2

A D V E R T I S E M E N T

   
 

The appendix is identified and a silk stay suture is placed at the tip. The tip is then removed and two additional stay sutures are placed to triangulate open the appendiceal lumen. An 8 French feeding tube is passed to ensure appendiceal patency.       

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Appendicostomy: 3

A D V E R T I S E M E N T

   
 

A cecal wrap is created in a fashion similar to a fundoplication. This prevents stool or enema fluid from leaking back out through the appendicostomy. The appendix is folded into various positions to determine which has the least likelihood of creating a kink at the cecal-appendiceal junction. The tube is then withdrawn and repassed several times to ensure easy passage across this junction.      

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This page was last modified on 5/7/1999.